Abstract:
The pathway to psychiatric care that delays the commencement of appropriate treatmentfollowing the onset of psychosis is associated with poorer illness outcomes. This study examinedthe pathways to psychiatric care among patients with mental illness receiving treatment atFederal Neuropsychiatric Hospital Calabar, Cross River State, Nigeria. It was a cross sectionaldescriptive survey of 216 respondents proportionately drawn from a populationof 991 patients. Data was collected using an adapted semi structured interview guide (World Health Organisation patient encounter form) and a questionnaire (Belief of cause of mentalillness). Data were analysed using frequencies, percentages, mean and standard deviations. Chi square test and Phi test were used to test the hypotheses at p ≤ 0.5 alpha level. The findings revealed that the most frequent first choice of help seeking was specialist psychiatric services(47.2%) which increased consistently in the subsequent pathways: second (67.9%); third (69.4%); and fourth (100%). The pattern of utilization of care showed that: in the second pathway 34.5% of respondents spent 5 years and above in the specialist psychiatric services, 72.4% used the services very frequently, 69.0% were consistent with the services and only 28.7% did not combine specialist psychiatric services with any other pathway; in the third pathway, 11.5% spent 7 months to 1 year in specialist psychiatric services, 19.5% used the services very frequently, 25.3% were not consistent with the services and 20.7% did not combine specialist psychiatric services with any other therapy; and in the fourth pathway 14.7% respondents spent 1 to 3 weeks in specialist psychiatric services, 29.4%used the services very frequently, 26.5% were consistent with the services and 17.6% combined the specialist psychiatric services with religious healing. The most identified reasons for the choices of the pathways to care were: influence of significant others (51.9%; 28.6%) for the first and third pathways respectively; and minimum improvement from previous treatment (36.7%; 66.7%) for the second and fourth pathways respectively.Most respondents believed that mental illness could be caused by every other thing except God Almighty (2.54 ± 1.06). There was no significant association between education (P= 0.090); economic status (employment status [P= 0.382]; level of income[P=0.189]); belief of cause of mental illness (scientific belief[P=0.325]; supernatural belief[P=0.159]) and the first choice of help seeking pathway. It was recommended that the government and hospital management should further promote access to specialist psychiatric services at all levels of the healthcare system.
